Breast Cancer Ranks High for Malpractice Claims


ACR Bulletin
August 1995

Most Recent PIAA Study

Breast cancer (and especially a delay in its diagnosis) accounts for more medical malpractice claims and suits than any other single disease or condition, according to a recent study by the Physician Insurers Association of America. The PIAA tracked over 125,000 claims and suits filed since 1985.

The PIAA Data Sharing Project also shows that breast cancer-related claims and suits have led to more money being paid out by malpractice insurance companies than any other single disease or condition except those involving brain-damaged infants.

Information from the Data Sharing Project shows that malpractice insurance carrier payments for breast cancer-related claims and suits have increased significantly over the past 10 years. For example, the report states that from 1985 to 1993 the average payment made to patients for claims related to delay in diagnosing breast cancer was over $190,000. Payments reported in the most recent six-month period (June through December 1994) averaged $307,000.

The PIAA Data Sharing Project also reveals:

  • In 24 percent of the claims, radiologists were named as defendants, closely followed by obstetricians/gynecologists (23 percent). Also named were family practitioners (17 percent), surgeons (14 percent), internists (9 percent), and other specialists (5 percent). Pathologists were named 2 percent of the time, as were hospitals. Corporations were named in 4 percent of the claims or suits.

  • According to PIAA, radiologists may have been named most frequently because of the increase in the number of women ­p; especially pre-menopausal women­p; who were seeking mammograms. Younger women''s breast tissue is more dense and therefore poses greater difficulty in detecting a lump through a mammogram.

  • Although pain is not commonly believed to be a characteristic of the early stages of breast cancer, in more than one quarter of the cases, the patients reported pain and tenderness (regardless of whether or not there was a lump present). A mass with no pain was reported in almost half of the cases. The mass was discovered initially by the patient (as opposed to through a screening mammogram or by a physician) in 60 percent of all cases.

Responding to the findings of the PIAA study, the American College of Radiology said:

"The PIAA data confirm the long-standing concern of the ACR over the importance of early detection of breast cancer. This concern has led ACR to support guidelines for regular breast cancer screening with mammography for women 40 years of age and over. The need for quality in mammography motivated the College to create its nationally recognized mammography accreditation program."

Furthermore, said the ACR, "We believe the increase in frequency of lawsuits against radiologists cited in the PIAA study is not a reflection of any reduction in quality. To the contrary, the quality of mammography has improved in the last five years. The increased frequency no doubt correlates with an increase in the number of women who are having mammograms (23.5 million in 1992 and approximately 25 million in 1994). Because more women are having this important test, an increased number of lawsuits is not surprising."

The results of the 1995 PIAA study regarding malpractice claims stemming from a failure to diagnose breast cancer were compared to those from a similar study conducted five years ago.

Comparison of the two studies shows shifts:

  • The average indemnity payment to the claimants increased 36 percent from $221,524 (1990 study) to $301,460 (1995 study). The average costs of "allocated loss adjustment expenses" - payments for lawyers, expert witnesses, and administration - rose 50 percent in the same time period - $19,400 (1990 study) to $28,700 (1995 study).

  • The incidences where the lesion was discovered by a screening mammogram was up significantly from 4 percent in the 1990 study to 10.7 percent in the 1995 study.

  • Cases involving a mammogram with a false negative or equivocal results reported are up from 68 percent (in 1990) to 80 percent (in 1995).

  • The incidences where the lump was discovered by the patient (as opposed to a physician or in a screening mammogram) was down moderately from 70.3 percent (1990) to 60 percent (1995).

  • The medical specialty named in the most number of claims and suits shifted from obstetricians/gynecologists (39 percent in 1990) to radiologists (24 percent in 1995). In the 1990 study, radiologists were named in 11 percent of the claims, and in the 1995 study, ob/gyns were named in 23 percent of the claims.

  • Claimants are slightly older. The average/median age in the 1990 study was 44 and 43, respectively. The average and median age for claimants in the 1995 study is 46 and 45, respectively.

The total number of claims reviewed was 487 from 33 PIAA member companies (32 throughout the U.S. and one company in New South Wales, Australia).

ACR said, "... increases in both frequency of suits and levels of payments for these malpractice claims reflect the overall explosion in litigation that is pervasive in our current tort liability system. This problem is being addressed by the Congress and state legislatures, which are considering the need for tort reform."